The Senior Care Pharmacy Coalition (SCPC) on Wednesday endorsed the Maximum Allowable Cost (MAC) Transparency Act, a bipartisan bill introduced by Reps. Doug Collins (R-GA) and Dave Loebsack (D-IA) that will expand payment transparency inside the Medicare prescription drug program.
SCPC President and CEO Alan Rosenbloom said in a letter to Collins and Loebsack that it is impossible for long-term care pharmacies to predict how they will be compensated for generic drugs distributed under Medicare Part D because of current pricing practices.
“Pharmacy Benefit Managers (PBMs) use Maximum Allowable Cost pricing to determine how much to reimburse pharmacies that dispense generic drugs to their covered patients. PBMs develop and alter their MAC pricing lists without disclosing how they determine which drugs to include on the lists, how those prices are established or how frequently those prices are updated, rendering the process completely opaque," Rosenbloom said.
Rosenbloom said that the legislation’s steps to guarantee the MAC reimbursement rates are clear and appropriate are encouraging, especially in light of recent generic drug price increases. More than 80 percent of the medications dispersed to Part D beneficiaries in (long-term care) locations are generic.
“In an era of sharply rising generic drug costs, the pharmacy industry is plagued by a lack of responsiveness by the PBMs to adjust MAC prices to reflect the increase in acquisition cost,” Rosenbloom said. “We are particularly pleased that H.R. 244 requires MAC lists to be updated every seven days with advanced public notice. Increased transparency is a step in the right direction to enable independent (long-term care) pharmacies to maintain the level of service Medicare beneficiaries deserve and the law and regulations require."
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